Aus der Klinik für Dermatologie, Venerologie und Allergologie der Medizinischen Fakultät Charité – Universitätsmedizin Berlin DISSERTATION Tanning pattern and sun protective behavior of students of Poznan University of Medical Sciences zur Erlangung des akademischen Grades Doctor medicinae (Dr. med.) vorgelegt der Medizinischen Fakultät Charité – Universitätsmedizin Berlin von Anna Francuzik (geb. Janecka) aus Poznań (Polen) Datum der Promotion: ..........14.02.2014........................ Tanning Pattern and Sun Protective Behavior Table of Contents 1 Abstrakt ............................................................................................................................. 5 2 Abstract ............................................................................................................................. 6 3 Introduction ....................................................................................................................... 7 3.1 History and Development of Tanning Culture ........................................................... 7 3.2 Prevalence and Correlates of Tanning ...................................................................... 7 3.2.1 Who Tans? ......................................................................................................... 7 3.2.2 Who is at Highest Risk of Developing Cancer? .................................................. 8 3.2.3 Adolescents and UV ........................................................................................... 8 3.2.4 Correlates of Tanning ......................................................................................... 9 3.3 Motivations for Tanning and Tanning Dependence ................................................... 9 3.3.1 Reasons for Tanning .......................................................................................... 9 3.3.2 Role of Media ................................................................................................... 10 3.3.3 Tanning Dependence ....................................................................................... 11 3.4 Fallacies and Controversies of Tanning Behavior Among Different Ethnic Groups 12 3.5 Biological Effects of Ultraviolet Radiation in Humans and Process of Skin Tanning12 3.5.1 The ABCDE Rule as an Early Indicator of Malignant Melanoma ..................... 14 3.5.2 The Fitzpatrick’s Phototyping Scale ................................................................. 14 3.6 Skin Cancer and Other Health Hazards of Tanning ................................................ 15 3.6.1 UV Light and Skin Cancer ................................................................................ 15 3.6.2 Indoor Tanning ................................................................................................. 16 3.6.3 Skin Cancer Incidence Worldwide .................................................................... 16 3.7 Sun Protective Behavior and Prevention of Skin Cancer ........................................ 16 3.7.1 Tanners’ Knowledge of Tanning Hazards ........................................................ 16 3.7.2 Sunscreen Products Usage .............................................................................. 17 3.7.3 Differences Between Opposite Genders in Sun Protective Behavior .............. 18 3.7.4 Parental Influence on Sun Protective Behavior ................................................ 18 3.7.5 Social Influence on Sun Protective Behavior ................................................... 18 3.7.6 Education as a Factor Influencing Sun Protective Behavior ............................ 19 3.7.7 Early Prevention Methods Aimed at Reducing Skin Cancer Incidence ............ 19 3.7.8 National Campaigns and Their Effect on Sun Protective Behavior .................. 20 4 The Aim of the Study ...................................................................................................... 22 5 Material and methods ..................................................................................................... 24 Anna Janecka 2 / 92 Tanning Pattern and Sun Protective Behavior 5.1 Study Population ..................................................................................................... 24 5.2 Questionnaire .......................................................................................................... 25 5.2.1 Demography ..................................................................................................... 25 5.2.2 Knowledge ........................................................................................................ 25 5.2.3 Attitude Towards Tanning ................................................................................ 25 5.2.4 Tanning Behavior ............................................................................................. 26 5.2.5 Experience with Sunburns in the Past .............................................................. 26 5.2.6 Education About Solar Damage and Sun Protection ....................................... 26 5.3 Statistical Analysis ................................................................................................... 26 6 Results ............................................................................................................................ 27 6.1 Demography ............................................................................................................ 27 6.1.1 Gender ............................................................................................................. 27 6.1.2 Skin Type ......................................................................................................... 27 6.1.3 Students’ Level of Education ............................................................................ 28 6.1.4 Students’ Parents’ Level of Education .............................................................. 29 6.1.5 Family History of Skin Cancer .......................................................................... 30 6.1.6 Personal History of Skin Cancer ...................................................................... 31 6.2 Knowledge ............................................................................................................... 32 6.2.1 Sunscreen Effectiveness .................................................................................. 32 6.2.2 SPF .................................................................................................................. 35 6.2.3 UV Radiation .................................................................................................... 36 6.3 Attitude Towards Tanning ........................................................................................ 37 6.4 Tanning Behavior .................................................................................................... 40 6.4.1 Tanning in the Sunlight ..................................................................................... 40 6.4.2 Tanning in the Tanning Studio ......................................................................... 43 6.4.3 Sunscreen Use ................................................................................................. 46 6.5 Experience with Sunburns in the Past ..................................................................... 50 6.5.1 Sunburns in the Sun ......................................................................................... 50 6.5.2 Sunburns in Tanning Studios ........................................................................... 51 6.5.3 Sunburns in Childhood ..................................................................................... 52 6.5.4 Sunburns and Activities .................................................................................... 53 6.5.5 Sunburns Experienced Last Summer ............................................................... 54 6.6 Education About Solar Radiation Damage and Sun Protection .............................. 56 6.6.1 Moles ................................................................................................................ 56 6.6.2 Sources of Information on Sun Protection ........................................................ 58 6.6.3 National Campaigns ......................................................................................... 59 Anna Janecka 3 / 92 Tanning Pattern and Sun Protective Behavior 6.7 Hypotheses .............................................................................................................. 59 7 Discussion ...................................................................................................................... 62 7.1 Knowledge ............................................................................................................... 62 7.2 Attitude Towards Tanning ........................................................................................ 63 7.2.1 Attitude Towards Skin Tone ............................................................................. 63 7.2.2 Attitude Towards Risk of Getting Sunburnt ...................................................... 63 7.3 Tanning Behavior .................................................................................................... 64 7.3.1 Tanning in the Sunlight and Tanning Studios .................................................. 64 7.3.2 Sunscreen Use ................................................................................................. 66 7.4 Experience with Sunburns